Allergy Asthma Immunol Res.  2010 Oct;2(4):267-270. 10.4168/aair.2010.2.4.267.

A Case of Recurrent Toxocariasis Presenting With Urticaria

• Kim MH
• Jung JW
• Kwon JW
• Kim TW
• Kim SH
• Cho SH
• Min KU
• Kim YY
• Chang YS

• KMID: 2260388
• DOI: http://doi.org/10.4168/aair.2010.2.4.267

Abstract

Human toxocariasis is the most prevalent helminthiasis in Korea and other industrialized countries. The clinical features of toxocariasis are diverse, according to the involved organ. Typically, Toxocara spp. infection is easily treated with 400 mg albendazole twice a day for 5 days. However, we experienced a case of recurrent toxocariasis that was refractory to this standard therapy and presented with urticaria, an uncommon symptom in toxocariasis. A 35-year-old male visited our emergency room because of abdominal pain. He had recently consumed raw cow liver (3 weeks prior to presentation). Laboratory analyses revealed eosinophilia (1,612 cells/microliter) and increased total IgE (3,060 IU/mL). Chest X-ray showed multiple lung nodules in both lungs, and computed tomography revealed multiple ground-glass opacities in both lungs and multiple tiny liver abscesses. Liver biopsy revealed an eosinophilic abscess. Enzyme-linked immunosorbent assay findings for Toxocara antigens were positive (optical density, 2.140), leading to a diagnosis of toxocariasis. We initiated a 5-day treatment with albendazole and prednisolone; however, 6 days after completing the treatment, the patient again experienced urticaria and severe itching that could not be controlled by antihistamines or hydrocortisone cream. A second bout of eosinophilia suggested recurring toxocariasis, for which we prescribed a second round of albendazole. Despite an initial improvement in his symptoms, the patient returned after 6 weeks complaining of abdominal pain for 6 hours, which was reminiscent of his first attack; he also exhibited eosinophilia. Accordingly, albendazole was administered once more for an additional 3 weeks, and his symptoms resolved.

Keyword

Abdominal pain; albendazole; toxocariasis; urticaria

MeSH Terms

Abdominal Pain
Abscess
Adult
Albendazole
Biopsy
Developed Countries
Emergencies
Enzyme-Linked Immunosorbent Assay
Eosinophilia
Eosinophils
Helminthiasis
Histamine Antagonists
Humans
Hydrocortisone
Immunoglobulin E
Korea
Liver
Liver Abscess
Lung
Male
Pruritus
Thorax
Toxocara
Toxocariasis
Urticaria
Albendazole
Histamine Antagonists
Hydrocortisone
Immunoglobulin E

Figure

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  Fig. 1 Multiple tiny liver abscesses in abdomen CT.

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  Fig. 2 Multiple ground-glass opacities in both lungs in chest CT.

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  Fig. 3 Patchy and dense eosinophilic infiltration in liver biopsy (H&E stain, A: ×200, B: ×400).

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  Fig. 4 Serial change of eosinophil count according to recurrence.

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